Provider Demographics
NPI:1174667174
Name:SHAWNEE FAMILY CARE PA
Entity Type:Organization
Organization Name:SHAWNEE FAMILY CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:913-631-6114
Mailing Address - Street 1:5949 NIEMAN RD
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66203-2907
Mailing Address - Country:US
Mailing Address - Phone:913-631-6114
Mailing Address - Fax:913-631-5263
Practice Address - Street 1:5949 NIEMAN RD
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66203-2907
Practice Address - Country:US
Practice Address - Phone:913-631-6114
Practice Address - Fax:913-631-5263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0423330261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSCB6830OtherMEDICARE RR GROUP
KSH24932OtherUPIN MARY K DEVERS
KS27992017OtherBLUE SHIELD GROUP
KSE66004OtherJOHN L CRANE UPIN
KSCB6830OtherMEDICARE RR GROUP